Med Surg chapter 42
A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? 1Common adverse effects 2Activity restrictions 3Dietary restrictions 4Loading-dose schedule
Common adverse effects
The client presents to the emergency department with fever, chills, restlessness, and limited movement of a fractured jaw. The nurse interprets these findings as indicating which of the following complications? 1Avascular necrosis 2Compartment syndrome 3Osteomyelitis 4Fat embolism
Osteomyelitis
The nurse is educating the patient with low back pain about the proper way to lift objects. What muscle should the nurse encourage the patient to maximize? 1Quadriceps 2Rectus abdominis 3Gastrocnemius 4Latissimus dorsi
Quadriceps
Morton's neuroma is exhibited by which of the following clinical manifestations? 1High arm and a fixed equinus deformity 2Swelling of the third (lateral) branch of the median plantar nerve 3Longitudinal arch of the foot is diminished 4Inflammation of the foot-supporting fascia
Swelling of the third (lateral) branch of the median plantar nerve
A nurse is performing discharge teaching for an elderly client with osteoporosis. Which instruction about taking a calcium supplement should the nurse include? 1Take weekly on the same day and at the same time. 2Take the supplement with meals or with orange juice. 3Take the supplement on an empty stomach with a full glass of water. 4Remain in an upright position 30 minutes after taking the supplement.
Take the supplement with meals or with orange juice.
A client has been treated for migraine headaches for several months and comes to the clinic stating he is getting no better. The nurse is talking with the client and hears an audible click when the client is moving his jaw. What does the nurse suspect may be happening? 1Loose teeth 2Dislocated jaw 3Trigeminal neuralgia 4Temporomandibular disorder
Temporomandibular disorder
The nurse is educating a patient with lower back pain on proper lifting techniques. The nurse would document what behavior as evidence the education was effective? 1The patient bent at the hips and tightened the abdominal muscles. 2The patient reached over head with arms fully extended. 3The patient used a narrow base of support. 4The patient placed the load close to the body.
The patient placed the load close to the body.
The nurse teaches the patient with a high risk for osteoporosis about risk-lowering strategies including which of the following actions? 1Reduce stress 2Increase fiber in the diet 3Decrease the intake of vitamin A and D 4Walk or perform weight-bearing exercises outdoors
Walk or perform weight-bearing exercises outdoor
Ms. Simpson has come to the clinic with foot pain. The physician has described her problem as a flexion deformity of the proximal interphalangeal joint. What is the name of this disorder? 1Heberden's nodes 2Mallet toe 3Hammer toe 4Hallux valgus (bunion)
Hammer toe
A patient diagnosed with carpal tunnel syndrome (CTS) asks the nurse about numbness in the fingers and pain in the wrist. In responding to the patient, how would the nurse best describe CTS? 1"CTS is a neuropathy that is characterized by pannus formation in the shoulder." 2"CTS is a neuropathy that is characterized by flexion contracture of the fourth and fifth fingers." 3"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist." 4"CTS is a neuropathy that is characterized by bursitis and tendinitis."
"CTS is a neuropathy that is characterized by compression of the median nerve at the wrist."
A nurse is teaching a client who was recently diagnosed with carpal tunnel syndrome. Which statement should the nurse include? 1"Surgery is the only sure way to manage this condition." 2"Using arm splints will prevent hyperflexion of the wrist." 3"This condition is associated with various sports." 4"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
"Ergonomic changes can be incorporated into your workday to reduce stress on your wrist."
The nurse has educated a patient with low back pain about techniques to relieve the back pain and prevent further complications. What statement by the patient shows understanding of the education the nurse provided? 1"I will avoid prolonged sitting or walking." 2"I will lie prone with my legs slightly elevated." 3"I will bend at the waist when I am lifting objects from the floor." 4"Instead of turning around to grasp an object, I will twist at the waist."
"I will avoid prolonged sitting or walking."
On a visit to the family physician, a client is diagnosed with a bunion on the lateral side of the great toe, at the metatarsophalangeal joint. Which statement should the nurse include in the teaching session? 1"Bunions are congenital and can't be prevented." 2"Bunions may result from wearing shoes that are too big, causing friction when the shoes slip back and forth." 3"Bunions are caused by a metabolic condition called gout." 4"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
"Some bunions are congenital; others are caused by wearing shoes that are too short or narrow."
A client with osteoporosis is prescribed calcitonin (Miacalcin) 100 units subcutaneously. The medication is available 200 units per ml. How many milliliters will the nurse administer to the client?
0.5
Which client would the nurse identify as having the greatest risk for osteoporosis? 1A 16-year-old male with a history of asthma 2A small-framed, thin 45-year-old white woman 3A 20-year-old male athlete with repeated injuries 4A 40-year-old overweight African American woman
A small-framed, thin 45-year-old white woman
The nurse is caring for patient with a hip fracture. The physician orders the patient to start on a bisphosphonate. Which medication would the nurse document as given? 1Alendronate (Fosamax) 2Teriparatide (Forteo) 3Denosumab (Prolia) 4Raloxifene (Evista)
Alendronate
Which medication classification is prescribed when allergy is a factor causing the skin disorder? 1Corticosteroids 2Local anesthetics 3Antibiotics 4Antihistamines
Antihistamines
The nurse is preparing a client for a surgical procedure that will allow visualization of the extent of joint damage of the knee for a client with rheumatoid arthritis and also obtain a sample of synovial fluid. What procedure will the nurse prepare the client for? 1Open reduction 2Arthroscopy 3Arthroplasty 4Needle aspiration
Arthroscopy
A nurse is caring for an elderly female client with osteoporosis. When teaching the client, the nurse should include information about which major complication? 1Bone fracture 2Negative calcium balance 3Dowager's hump 4Loss of estrogen
Bone fracture
A patient has been diagnosed with osteomalacia. What common symptoms does the nurse recognize that correlate with the diagnosis? 1Bone fractures and kyphosis 2Softened and compressed vertebrae 3Muscle weakness and spasms 4Bone pain and tenderness
Bone pain and tenderness
What food can the nurse suggest to the client at risk for osteoporosis? 1Bananas 2Broccoli 3Chicken 4Carrots
Broccoli
Which group is at the greatest risk for osteoporosis? 1African American women 2Caucasian women 3Men 4Asian women
Caucasian women
Which assessment findings would the nurse expect to find in the client with osteomyelitis? 1Column A 2Column B 3Column D 4Column C
Column B
An older adult female has a bone density test that reveals severe osteoporosis. What does the nurse understand can be a problem for this client due to the decrease in bone mass and density? 1Cardiac disease 2Compression fractures 3Diabetes 4Hypertension
Compression fractures
Which of the following is a flexion deformity caused by a slowly progressive contracture of the palmar fascia? 1Callus 2Dupuytren's contracture 3Hallux valgus 4Hammertoe
Dupuytren's contracture
Which of the following was formerly called a bunion? 1Ganglion 2Morton's neuroma 3Hallux valgus 4Plantar fasciitis
Hallux valgus
The provider asks a nurse to test a patient for Tinel's sign to diagnose carpal tunnel syndrome. The nurse asked the patient to: 1Stretch his fingers around a ball and squeeze with force. 2Make a fist and open his hand against resistance. 3Hold his palm up while the nurse percussed over the median nerve. 4Pronate his hand while the nurse palpated the radial nerve.
Hold his palm up while the nurse percussed over the median nerve.
A group of students are reviewing information about osteoporosis in preparation for a class discussion. The students demonstrate a need for additional review when they state which of the following as a risk factor? 1Hypothyroidism 2Prolonged immobility 3Excess caffeine intake 4Prolonged corticosteroid use
Hypothyroidism
Which of the following should be included in the teaching plan for a patient diagnosed with plantar fasciitis? 1Management of plantar fasciitis includes stretching exercises. 2The pain of plantar fasciitis diminishes with warm water soaks. 3Complications of plantar fasciitis include neuromuscular damage and decreased ankle range of motion. 4Plantar fasciitis presents as an acute onset of pain localized to the ball of the foot that occurs when pressure is placed upon it and diminishes when pressure is released.
Management of plantar fasciitis includes stretching exercises
Primary prevention of osteoporosis includes: 1Using a professional alert system in the home in case a client falls when she's alone. 2Placing items within the client's reach. 3Installing grab bars in the bathroom to prevent falls. 4Optimal calcium intake and estrogen replacement therapy.
Optimal calcium intake and estrogen replacement therapy.
The nurse is caring for a client following foot surgery. Which nursing intervention is most important for the nurse to include in the nursing care plan? 1Examine surgical dressing every hour. 2Administer pain medication per client request. 3Perform neuromuscular assessment every hour. 4Monitor vital signs every 4 hours.
Perform neuromuscular assessment every hour.
Which of the following terms refers to disease of a nerve root? 1Contracture 2Sequestrum 3Radiculopathy 4Involucrum
Radiculopathy
The nurse is reviewing the medication administration record of the client. Which of the following medications would lead the nurse to suspect that the client is at risk for osteoporosis? 1raloxifene (Evista) 2plicamycin (Mithracin) 3penicillamine (Cuprimine) 4methotrexate (Rheumatrex)
Raloxifene
A client has Paget's disease. An appropriate nursing diagnosis for this client is: 1Delayed wound healing 2Fatigue 3Risk for falls 4Risk for infection
Risk for falls
Which of the following is the most important nursing diagnosis for an elderly patient diagnosed with osteoporosis? 1Acute pain related to fracture and muscle spasm 2Risk for injury related to fractures due to osteoporosis 3Risk for constipation related to immobility 4Deficient knowledge about osteoporosis and the treatment regimen
Risk for injury related to fractures due to osteoporosis
The nurse advises a patient that the best position to ease low back pain is: 1Prone, with a pillow under the shoulders. 2Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees. 3Supine, with the bed flat and a firm mattress in place. 4High-Fowler's to allow for maximum hip flexion.
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees.
A patient with chronic osteomyelitis has undergone 6 weeks of antibiotic therapy. There is no improvement in the wound appearance. What action would the nurse anticipate to promote healing? 1Surgical debridement 2Wound packing 3Vitamin supplements 4Wound irrigation
Surgical debridement
In chronic osteomyelitis, antibiotics are adjunctive therapy in which of the following situations? 1Wound packing 2Wound irrigation 3Surgical debridement 4Vitamin supplements
Surgical debridement
A nurse is caring for a client who's experiencing septic arthritis. This client has a history of immunosuppressive therapy and his immune system is currently depressed. Which assignment is the most appropriate for the nurse caring for this client? 1The nurse caring for this client is also caring for four clients receiving chemotherapy for cancer treatment on the oncology floor. 2The nurse caring for this client is also caring for two other immunosuppressed clients on the medical intensive care unit. 3The nurse is caring for this client on the intensive care unit. 4The nurse caring for this client is also caring for four other immunosuppressed clients on the medical floor.
The nurse is caring for this client on the intensive care unit.
A nurse is planning discharge teaching regarding exercise for a client at risk for osteoporosis. Which of the following exercises would be appropriate? 1Bicycling 2Yoga 3Swimming 4Walking
Walking
The nurse is assisting a client with removing shoes prior to an examination and observes that the client has a flexion deformity of several toes on both feet of the proximal interphalangeal (PIP) joints. What can the nurse encourage the client to do? 1Do active range of motion on the toes. 2Have surgery to fix them. 3Bind the toes so that they will straighten. 4Wear properly fitting shoes.
Wear properly fitting shoes
During a routine physical examination on a 75-year-old female client, a nurse notes that the client is 5 feet, 3/8 inches (1.6 m) tall. The client states, "How is that possible? I was always 5 feet and 1/2? (1.7 m) tall." Which statement is the best response by the nurse? 1"There may be some slight discrepancy between the measuring tools used." 2"The posture begins to stoop after middle age." 3"After age 40, height may show a gradual decrease as a result of spinal compression" 4"After menopause, the body's bone density declines, resulting in a gradual loss of height."
"After menopause, the body's bone density declines, resulting in a gradual loss of height."
A client with diabetes punctured hisfoot with a broken acorn in the yard. Within a week, the client developed osteomyelitis of the foot. The client was admitted for IV antibiotic therapy. How long does the nurse anticipate the client will receive IV antibiotics? 1 7 to 10 days 2 3 months 3 6 months 4 3 to 6 weeks
3 to 6 weeks
The client diagnosed with osteosarcoma is scheduled for a surgical amputation. Which nursing diagnosis would be a priority for this client compared with other surgical clients? 1Inadequate nutrition 2Impaired physical mobility 3Risk for infection 4Disturbed body image
Disturbed body image
A client with osteoporosis is prescribed a selective estrogen receptor modifier (SERM) as treatment. The nurse would identify which drug as belonging to this class? 1Alendronate 2Tamoxifen 3Calcium gluconate 4Raloxifene
Raloxifene
Which of the following presents with an onset of heel pain with the first steps of the morning? 1Ganglion 2Hallux valgus 3Morton's neuroma 4Plantar fasciitis
Plantar Fasciitis
A nurse is teaching a female client about preventing osteoporosis. Which teaching point is correct? 1Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss. 2The recommended daily allowance of calcium may be found in a wide variety of foods. 3To prevent fractures, the client should avoid strenuous exercise. 4Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
The recommended daily allowance of calcium may be found in a wide variety of foods.
Of the following, which is not a risk factor for osteoporosis? 1Being postmenopausal 2Family history 3Small-framed, thin White or Asian women 4Being male
Being male
A provider asks the nurse to teach a patient with low back pain how to sit in order to minimize pressure on the spine. Which of the following teaching points would the nurse include? Select all that apply. 1Sit with the buttocks "tucked under." 2Place feet flat on the floor. 3Sit in a straight-backed chair with arm rests. 4Avoid hip extension. 5Use a firm pillow placed behind the thoracic vertebrae to straighten the small of the back.
Sit in a straight-backed chair with arm rests. Avoid hip extension. Place feet flat on the floor. Sit with the buttocks "tucked under."
The nurse is planning discharge instructions for the client with osteomyelitis. What instructions should the nurse include in the discharge teaching? 1"You need to perform weight-bearing exercises twice a week." 2"Use your continuous passive motion machine (CPM) 2 hours each day." 3"You need to limit the amount of protein and calcium in your diet." 4"You will receive IV antibiotics for 3 to 6 weeks."
"You will receive IV antibiotics for 3 to 6 weeks."
A patient is diagnosed with osteogenic sarcoma. What laboratory studies should the nurse monitor for the presence of elevation? 1Magnesium level 2Alkaline phosphatase 3Potassium level 4Troponin levels
Alkaline phosphatase
When performing a physical assessment of a client, the client reports numbness, tingling, and pain when the nurse percusses lightly over the median nerve. The nurse recognizes that this finding is consistent with: 1Dupuytren's contracture 2Impingement syndrome 3Morton's neuroma 4Carpal tunnel syndrome
Carpal Tunnel Syndrome
When an infection is blood borne the manifestations include which of the following symptoms? 1Hypothermia 2Bradycardia 3Hyperactivity 4Chills
Chills
When describing malignant bone tumors to a group of students, which of the following would the instructor cite as the usual location? 1Wrist-hand junction 2Distal femur around the knee 3Femur-hip area 4Proximal humerus
Distal femur around the knee
The nurse notes that the patient's left great toe deviates laterally. This finding would be recognized as which of the following? 1Hallux valgus 2Pes cavus 3Hammertoe 4Flatfoot
Hallux valgus
A patient has been prescribed alendronate (Fosamax) for the prevention of osteoporosis. Which of the following is the highest priority nursing intervention associated with the administration of the medication? 1Encourage patient to get yearly dental exams 2Assess for the use of corticosteroids 3Have patient sit upright for 60 minutes following administration 4Ensure adequate intake of vitamin D in the diet
Have a patient sit upright for 60 minutes following administration
A nurse notices a client lying on the floor at the bottom of the stairs. He's alert and oriented and states that he fell down several stairs. He denies pain other than in his arm, which is swollen and appears deformed. After calling for help, what should the nurse do? 1Place the client in a sitting position. 2Raise the client's arm above his heart. 3Help the client walk to the nearest nurses' station. 4Immobilize the client's arm.
Immobilize the client's arm
A patient visits an orthopedic specialist because of pain that he feels beginning in his low back and radiating behind his right thigh and down below his right knee. The doctor suspects a diagnosis of sciatica. The nurse knows that the origin of the pain is between these intervertebral disks: 1 L4, L5, and S1 2 L2, L3, and L5 3 C3, C4, and L1 4 L1, L2, and L4
L4, L5, and S1
Which area of the spinal column is subject to the greatest mechanical stress and degenerative changes? 1Cervical 2Thoracic 3Lower lumbar 4Upper lumbar
Lower lumbar
Which of the following is the most common and most fatal primary malignant bone tumor? 1Osteogenic sarcoma (osteosarcoma) 2Rhabdomyoma 3Enchondroma 4Osteochondroma
Osteogenic sarcoma (osteosarcoma)
A patient had hand surgery to correct a Dupuytren's contracture. What nursing intervention is a priority postoperatively? 1Having the patient exercise the fingers to avoid future contractures 2Changing the dressing 3Applying a cock-up splint and immobilization 4Performing hourly neurovascular assessments for the first 24 hours
Performing hourly neuromuscular assessments for the first 24 hours
The nurse recognizes that goal of treatment for metastatic bone cancer is to: 1Cure the diseased bone and cartilage 2Reconstruct the bone with a prosthesis 3Promote pain relief and quality of life 4Diagnose the extent of bone damage
Promote pain relief
Which of the following positions should be avoided in severe back pain? 1Head and thorax elevated 30 degrees 2Prone 3Lateral recumbent 4Supine
Prone
A patient is having low back pain. What position can the nurse suggest to relieve this discomfort? 1Supine, with the bed flat and a firm mattress in place 2High-Fowler's to allow for maximum hip flexion 3Prone, with a pillow under the shoulders 4Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
Supine, with the knees slightly flexed and the head of the bed elevated 30 degrees
Which sign may be helpful in identifying carpal tunnel syndrome? 1Kernig's 2Tinel's 3Babinski's 4Brudzinski's
Tinel's
A client with low back pain is being seen in the clinic. In planning care, which teaching point should the nurse include? 1Sleep on the stomach to alleviate pressure on the back. 2Avoid twisting and flexion activities. 3Use the large muscles of the leg when lifting items. 4A soft mattress is most supportive by conforming to the body.
Use the large muscles of the leg when lifting items.
A male patient with a musculoskeletal injury is instructed to alter his diet. The objective of this diet alteration is to facilitate the absorption of calcium from food and supplements. Considering the food intake objective, which of the following food items should the nurse encourage the patient to include in the diet? 1Vitamin D-fortified milk 2Red meat 3Green vegetables 4Bananas
Vitamin D-fortified milk
Select all of the following that are descriptors of the pathophysiologic process seen in osteomalacia. 1A deficiency of activated vitamin D (calcitriol) 2The bone mass is structurally weaker, and bone deformities occur. 3Calcium and phosphate are not moved to the bones. 4Excessive osteoclastic activity causes the bones to become soft and bowed initially; later, the bones thicken but are not well formed, making the bones weak and prone to fracture.
A deficiency of activated vitamin D (calcitriol) Calcium and phosphate are not moved to the bones. The bone mass is structurally weaker, and bone deformities occur
Which medication directly inhibits osteoclasts thereby reducing bone loss and increasing bone mass density (BMD)? 1Teriparatide (Forteo) 2Vitamin D 3Calcitonin (Miacalcin) 4 Raloxifene (Evista)
Calcitonin
Which of the following inhibits bone resorption and promotes bone formation? 1Parathyroid hormone 2Calcitonin 3Estrogen 4Corticosteroids
Calcitonin
During a routine physical examination of a client, the nurse observes a flexion deformity of the promixal interphalangeal (PIP) joint of two toes on the right foot. The nurse documents this finding as which of the following? 1Hammer toe 2Mallet toe 3Bunion 4Hallux valgus
Hammer toe
A 35-year-old client is visiting a rheumatology group practice. The client has experienced increasing pain and progressing inflammation of the hands and feet. The rheumatologist has prescribed NSAID use to treat the condition. What client education is most important for the nurse to address with the use of these medications? 1Dietary restrictions 2Activity restrictions 3Common adverse effects 4Loading-dose schedule
Common adverse effects